From my PhD and MD, I deeply understand the brain as an electro-chemical organ, affected by both nature and nurture in a constant dynamic fashion. This drives neuropsychiatric treatments: medications (chemical), TMS and ECT (electrical), and therapy (nurture).

I have had the privilege of working with diverse people - Luo farmers in Kenya to British royalty to homeless San Franciscans. This informs my perspective on a daily basis. Btw, Dholuo is one of the hardest languages for a non-native speaker to learn. It has no regular verbs!

Mental illness and wellness are at the ends of a spectrum, with degrees of distress between them.  All people shift along that spectrum all the time.  Some dip into illnesses like major depression, bipolar disorder, schizophrenia, anxiety disorders, OCD, ADHD, PTSD.… For others, those diagnostic entities don’t address what’s really going on during hard times. In any case, I seek to help people recover.

I judiciously prescribe medications for psychiatric and substance use disorders and deprescribe as appropriate. I am skilled at differentiating primary psychiatric illnesses, psychiatric symptoms secondary to substance use, and comorbid psychiatric and substance use disorders and determining whether medications have a role or not.

Modalities include CBT, DBT, ACT, IPT, CPT, attachment, schema, and psychoanalytic approaches. Goals include integration, comfort with ambiguity, psychological flexibility, rebalancing life, and finding meaning.

Issues include medically safe detoxification and withdrawal management as well as maintenance of sobriety and harm reduction. Opioids, benzodiazepines, alcohol, cannabis, stimulants, tobacco….

The fascinating neural underpinnings of executive functions such as working memory, emotion regulation, and attention. Also normal aging and cognitive decline, which is what initially drew me into healthcare…. As a teenager, I worked as a nurses’ aide with people with dementia/Alzheimer disease, including a dear friend’s grandmother. The experience grounds and guides my work to date.

Understanding that everyone experiences trauma at some point, and that trauma does not equal traumatized. The spectrum of responses to the spectrum of traumas, including normal responses to abnormal situations. Asking not “what’s wrong with you,” but “what happened to you?”

Disillusionment (which I believe is more accurate than burnout) in healthcare, education, and other dedicated essential workers following the heartbreaking pandemic. Relates to moral injury. Causes pain. Spurs growth.

Even before Covid-19, I was often a doctor’s doctor. Needs have grown. I help doctors care for themselves and continue to serve others.

Care for victims of crime and offenders. Consideration of criminality and sociopathy as distinct from mental illnesses. Collaborative behavioral health courts, functions and components of judicial systems, approaches to justice locally and globally and their mental health impacts

Global perspective on HIV and other STIs. Sexual health as it relates to relationship power and mental wellbeing and distress.

Mental health and cognition as they relate to hormonal changes over the lifespan of women. Systemic challenges faced by women globally. Flipping scripts about gender. Strength among women globally.

Exploring impacts of expectations - about work, finances, emotions, and connection - for men. Setting aside those expectations, and concepts of gender, as needed.